Contessa, the innovation and high-acuity arm of Amedisys Inc. (NASDAQ: AMED) has made large investments in expanding access to palliative care, particularly through joint ventures with health systems.

Amedisys acquired Contessa in 2021 for $250 million. The subsidiary’s specialty is high-acuity care in the home, including hospital-at-home and skilled nursing facility-at-home programs, but in recent years it has also leaned hard into growing its palliative care business.

For now, Amedisys shows no signs of slowing down on palliative care. Expanding palliative care relationships and joint venture partnerships is a priority for 2024, the Louisiana-based home health and hospice provider indicated in a filing with the U.S. Securities and Exchange Commission (SEC) earlier this year.

“Our expertise and capabilities in these areas deliver value to both the health system and the health insurance payer and give us the opportunity for future expansion within the health care continuum for chronically ill patients, including palliative care services, especially as the U.S. population ages and consumer preferences continue to shift to home-based care,” the company noted in the filing. “Our joint venture partnership model with leading health care systems and our relationships with health plan insurers facilitate our ability to take and manage additional risk for this patient population in value-based arrangements.”

As of Dec. 31, 2023, Contessa was a stakeholder in at least 10 joint ventures that were actively admitting patients, according to the SEC filing. Among them are JVs with Mount Sinai Health System, Baylor Scott & White Health, Memorial Hermann Health System and Henry Ford Health System, each of which offers palliative care in addition to other services. 

In addition to these types of partnerships, Contessa also contracts directly with some payers, primarily Medicare Advantage plans.

“We have both joint venture models as well as direct to payer models, and we’ve been in multiple conversations about growing both of those lines of business,” Dr. Gavin Baumgardner, national medical director for palliative and complex care for Contessa, told Hospice News. “We’re seeing internal growth within those existing programs.”

Contessa’s JVs have a similar structure and clinical model. The joint ventures’ boards have a 50/50 split among members from each partner with oversight by a dedicated medical director. Contessa provides nurse practitioner managers, field staff, virtual care clinicians, data and analytics services, marketing and supplies, Dawn Black, clinical manager for palliative care at home at Contessa Health, said in a presentation at the National Hospice and Palliative Care Organization’s Annual Leadership Conference in Denver.

The health systems in these partnerships bring the electronic medical record system, program medical directors, policies and procedures, educational materials and direct referrals. The JV’s branding also generally aligns with that of the health care system, Black said.

The joint ventures also involve contracts with insurance companies, including Contessa’s partnerships with Henry Ford and Mt. Sinai.

“The insurance company provides the patient data and claims,” Black said during the presentation. “So both the joint ventures have a contract with an insurance company. For Henry Ford Health, they have their own internal insurance company, and we have a contract with them.”

The JVs’ care methodology adheres to National Coalition for Hospice and Palliative Care guidelines and represents a longitudinal care management model. Short lengths of stay are rare among Contessa’s palliative care patients, according to Baumgardner. Generally, the program serves patients with a prognosis of 18 months to two years.

Each patient has a risk score based on an algorithm that uses data pertaining to each individual gleaned from Contessa and the insurance company. This largely determines the frequency of home visits by the interdisciplinary team. That team includes nurse practitioners, social workers, nurses and community health workers, Baumgardner indicated. The program also offers patients and families 24/7 virtual care, he said.

The payment models associated with these joint ventures involve both upside and downside risk, according to Baumgardner.

Risk-based contracts with payers are structured around estimates of the expected costs necessary to address the patients’ health care needs. These models typically involve capitation, bundled payments and shared savings arrangements.

Generally, upside risk means that the palliative care provider could receive a percentage of any savings they generate. With downside risk, the provider may be required to cover the difference if actual costs of care exceed the budgeted expenses.

A key consideration is to understand the needs of all parties involved, such as the health system and the contracted insurance companies.

“First and foremost, you have to understand what are the problems you’re trying to solve, and then, mutually, you design a clinical model and an operational model that can meet those needs and solve those problems,” Baumgardner said. “We should avoid trying to wedge a clinical model into every scenario. I think that is fraught with a lot of peril, in the sense that you can create a lot of frustration for both sides. So starting with the conversation about what problem we’re trying to solve, and then mutually designing a clinical model that meets those needs is extremely important.”